The proposed Center for American Indian and Alaska Native Health Disparities (CAIANHD) will be organized in terms of 5 Core components: an Administrative Core (Core A), a Research Core (Core B), a Community Outreach and Information Dissemination Core (Core C), a Native Investigator Training Core (Core D), and a Shared Resources Core (Core E). Spero M Manson, Ph.D., Professor and Head, American Indian and Alaska Native Programs (AIANP), University of Colorado Health Sciences Center (UCHSC), will serve as Principal Investigator and will lead the Research Core. Dr. Manson, a medical anthropologist, is American Indian (Pembina Chippewa) and is nationally recognized for his research and leadership in areas directly relevant to all aspects of this comprehensive (P60) Project EXPORT Center proposal to understand and eliminate health disparities among American Indians and Alaska Natives. The Research Core houses 4 full research projects and 5 pilot research projects. These projects address 6 of the 7 elements of the health disparities initiative as described in the NCMHD Project EXPORT RFA. Specifically, this core will plan and carry out an interdisciplinary, culturally grounded, problem-oriented research program of major scientific and programmatic importance to the health status and functioning of AI/ANs, with particular emphasis on the quality of diabetic care for AI youth, telepsychiatry, obesity among AI infants and children, cancer incidence and quality of care, chlamydia screening of AI youth, increasing fitness of urban AlAN youth, smoking cessation, understanding the performance properties of a widely used health quality measure, and assessing/improving the quality of mental health care for AI children. The research projects that comprise this RPP are informed and subsequently linked by a multi-level perspective on health behavior, health status, and change therein. We are especially interested in how the health care systems available to and employed by Native people can induce, reinforce, and sustain desired change: hence, our concern with the quality of their care. A widely quoted Institute of Medicine definition describes quality of care as the "degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge". This definition suggests that quality of care can be affected at different levels of emphasis (e.g., the individual patient and his/her family to groups of patients and families), from different perspectives (e.g., patients, families, clinicians, programs), and can be measured in terms of a variety of desired outcomes. Our thinking along these lines is guided by Donabedian and others, who have offered the well-known conceptual framework of Structure, Process, and Outcome, to which we have added an additional domain, Patient and Family Characteristics. As noted, different kinds and levels of emphasis can be considered in seeking to ascertain and to influence the quality of care. To-date, we have focused on the clinician-patient interaction as well as program-level activities, and do so here, although in a more elaborate and comprehensive fashion.